Therapeutic challenges in elderly patients with symptomatic hypercalcaemia caused by primary hyperparathyroidism.
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BACKGROUND: Hypercalcaemia resulting from primary hyperparathyroidism (PHPT) can cause a wide range of symptoms, including cognitive disorders, psychiatric symptoms and muscle weakness. Parathyroid surgery is the only definite cure for PHPT. When surgery is contraindicated or patients decide against it, several non-surgical treatment options are available. OBJECTIVE: To illustrate the treatment options of symptomatic hypercalcaemia caused by PHPT in the elderly and discuss these options in consideration of the available evidence. DESIGN: Consecutive case series. SETTING: University hospital. PATIENTS: Four older patients aged 79-87 years with symptomatic hypercalcaemia resulting from PHPT. RESULTS: Three patients had a parathyroid adenoma shown on a sestamibi scan. Normocalcaemia and resolution of symptoms was achieved by different treatment scenarios encompassing forced saline hydration, forced diuresis, intravenous pamidronate and cinacalcet, a calcimimetic drug. In one patient, no parathyroid abnormalities were revealed with imaging. Treatment with cinacalcet resulted in normocalcaemia and a strong improvement of symptoms. CONCLUSION: In clinical practice, different treatment scenarios are chosen for the treatment of elderly patients with symptomatic hypercalcaemia caused by PHPT. The introduction of cinacalcet offers a new treatment paradigm. We propose to apply cinacalcet preceding elective surgery as an alternative option to standard therapy or as maintenance dose when surgery is not possible. (+info)
Short-term use of cinacalcet in children on regular hemodialysis.
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INTRODUCTION: Therapy with vitamin D3 analogs suppress the parathyroid hormone (PTH) secretion in chronic kidney disease (CKD) patients suffering from secondary hyperparathyroidism (sHPT). The concurrent administration of calcium-containing phosphate binders further increases the likelihood of developing hypercalcemia. Calcimimetics, such as cinacalcet, lower PTH level while limiting the risks of hyperphosphatemia and/or hypercalcemia. In adults, clinical experience with calcimimetics has shown significant reductions in PTH levels in cases with sHPT, but the clinical experience in children with CKD is limited. CASE SERIES: We report here the effect of short term use of cinacalcet on sHPT in two children on regular hemodialysis for CKD stage 5. Both children had very high PTH level which failed to be controlled with vitamin D3 and phosphate binders. We started cinacalcet therapy at a dose of 30 mg/day for both of them for duration of eight weeks. The first case was an 11 year-old male, his iPTH level decreased by 26% at four weeks after initiation of therapy and decreased by 39% at eight weeks. The second case was a 13 year-old female, her iPTH level decreased by 25% at four weeks after therapy and by 40% at eight weeks. There were no drug related side effects in both cases. Serum calcium and phosphorus levels remained stable in both patients. CONCLUSION: Cinacalcet can be effectively used in the treatment of sHPT in children in the short term, with minimal changes in the serum levels of calcium and phosphorus. (+info)
Calcimimetic R-568 and its enantiomer S-568 increase nitric oxide release in human endothelial cells.
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Effect of secondary hyperparathyroidism treatment with cinacalcet on selected adipokines and markers of endothelial injury in hemodialysis patients: a preliminary report.
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